恶性肿瘤患者放化疗后真菌感染危险因素与耐药性分析

Risk factors of fungal infections in malignant tumor patients after chemotherapy or radiotherapy and analysis of drug resistance

目的了解恶性肿瘤患者放化疗后真菌感染的菌种分布,诱发真菌感染的危险因素及对常用抗菌药物的耐药性,为有效预防与控制医院恶性肿瘤患者放化疗后真菌感染提供依据。方法对医院2009年1月-2011年3月送检的436例恶性肿瘤患者放化疗后痰液、血液、胸腹水、尿液、粪便等标本进行真菌培养及药敏试验。结果 436例恶性肿瘤患者标本中共检出真菌86株,感染率为19.72%;其中以呼吸道感染最多,占55.8%;菌种以白色假丝酵母菌为首,占60.5%,其次是热带假丝酵母菌,占12.8%;抗菌药物的滥用、大量激素的使用及侵入性操作等是真菌感染的危险因素;真菌对所选择的6种抗菌药物均有不同程度耐药性,其中对酮康唑耐药率最高,达26.7%,对益康唑和咪康唑的耐药率也较高,分别为18.6%、17.4%。结论在对恶性肿瘤患者的治疗过程中,根据药敏试验结果合理应用有效抗真菌药物,防止滥用抗菌药物,是预防及控制真菌感染的有效途径。

OBJECTIVE To study the distribution of fungi causing infections in the malignant cancer patients after chemotherapy or radiotherapy, explore the risk factors that induce the fungal infections, and analyze the drug resistance to the commonly used antibiotics so as to put forward effective measures for prevention and control of the fungal infections. METHODS The fungal culture was performed for the blood, urine and feces specimens collected from 436 cases of malignant caner patients from Jan 2009 to Mar 2011, and the drug susceptibility testing was carried out . RESULTS A total of 86 strains of fungi were detected in 436 cases, the positive rate was 19.72%, of which the respiratory tract infection was the most common, accounting for 55.8%. Candida albicans was the most prevalent species of fungi, accounting for 60. 5%, followed by the Candida tropicalis （12.8%）. The overuse of antibiotics or hormones and the invasive procedures were the risk factors for the fungal infections. The fungi varied in the drug resistance to the six antibiotics tested, the drug resistance rate to ketoconazole was the highest 26. 70%, and the drug resistance rates to enconazole and miconazole were as high as 18. 6% and 17.4%, respectively. CONCLUSION During the treatment of the patients with malignant tumor, it is an effective way to prevent and control the fungal infections through reasonably using sensitive antibiotics based on the drug susceptibility testing result and preventing the over use of antibiotics.